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Introduction: Two-stage revision is the gold standard for chronic periprosthetic joint infection (PJI). The removal of well-fixed implants, especially the femoral component, can be extremely difficult and additional osteotomies may be needed, which is time-consuming and results in bone stock loss. When the femoral stem is osseointegrated, there is no clear indication for the use of partial two-stage revision. The primary objective was to assess infection eradication after surgery. Methods: Retrospective study of specific case series. A total of eight patients with a chronic uncemented PJI, in the setting of complex revision surgeries, were treated with partial two-stage revision, which included selective retention of the well-fixed femoral component and complete acetabular removal. Stem retention was carried out regardless of the bacteria or associated comorbidities. Results: All patients were re-revision cases with at least two previous surgeries (range, 2–4). Complex revisions were performed in five cases (non-articulated spacer) and simple revisions in three cases (articulated spacer). The minimum follow-up time was 24 months (range, 24–132 months). The infection eradication rate at final follow-up was 100%. Conclusion: Partial two-stage reconstruction is a promising technique for the treatment of chronic PJI in patients with a well-fixed stem and complex re-revision acetabular procedures. Further prospective studies and prolonged follow-ups are required to confirm our results.

Resumen: La artrodesis posterior instrumentada con tornillos pediculares mediante manos libres y con monitorización neurofisiológica intraoperatoria es la técnica quirúrgica más común en cirugía de escoliosis idiopática del adolescente. Una complicación descrita durante este tipo de intervenciones es el neumotórax. La estimulación de los tornillos pediculares es la técnica neurofisiológica empleada para la detección del mal posicionamiento de los mismos y para prevenir lesiones neurológicas iatrogénicas. Presentamos 2 casos clínicos en los que la caída unilateral de los umbrales de los tornillos pediculares se asocia a neumotórax ipsilateral. Para detectar un neumotórax, hay que realizar una radiografía de tórax postoperatoria. Sin embargo, esta práctica ha sido cuestionada debido a la baja incidencia de esta complicación. A raíz de la asociación descrita en este trabajo, consideramos que ante un descenso o asimetría en los umbrales de los tornillos pediculares debemos sospechar y descartar la existencia de un neumotórax. Abstract: Posterior spinal instrumentation and fusion with pedicle screws inserted by free-hand technique and controlled by multimodal intraoperative monitoring is the most common technique in adolescent idiopathic scoliosis surgery. Pneumothorax is a described complication of this kind of procedure. Triggered electromyography is used to identify pedicle wall breakthrough and prevent neurological injuries. We report 2 clinical cases in which unilateral decrease in triggered electromyography values associate with ipsilateral pneumothorax. Postoperative chest radiographs need to be done in order to diagnose a pneumothorax. However, routinely performing a chest radiograph has been questioned because of the low incidence of this surgical complication. As a result of the association described in this article, we consider that when a unilateral decrease in triggered electromyography values is detected, a hidden pneumothorax should be suspected and ruled out.

This observational, cross-sectional case-control study evaluates the impact of coronavirus disease 2019 (COVID-19) on health-related quality of life (HRQoL) in elderly persons who have undergone surgery for adult spinal deformity (ASD). On December 31, 2019, the Chinese authorities first reported severe acute respiratory syndrome coronavirus 2, and on March 11, 2020, it was declared a pandemic. The pandemic seems to have had a negative effect on elderly patients who underwent ASD, in terms of functional and psychological quality of life. We selected patients with ASD aged70 years who had undergone surgery between 2010 and 2015 and compared them with age- and sex-matched patients who did not have ASD. We recorded sociodemographic variables, type of surgery, levels of spinal fusion, HRQoL (Scoliosis Research Society-22, Short Form 12 Health Survey, EuroQol-5D [EQ-5], Geriatric Depression Scale [Yesavage] [GDS], Modified Frailty Index-11, and Barthel index), fear of visiting a health center, fear of leaving one's house, and adherence to preventive measures. The study population comprised 174 patients (mean [standard deviation] age, 77.3 [5.9] years; 86% women), of whom 87 had undergone surgery for ASD. The incidence of COVID-19 was higher in patients aged85 years (P = .041), urban areas (P = .047), and in patients in long-term care (P = .03). Similarly, no differences were observed for the ability to cope with the pandemic (P.05). Patients who underwent surgery also had a higher risk of depression (GDS, 6.7 [P = .02]), a lower EQ-5 score (P = .001), a higher body mass index (P = .004), greater consumption of drugs (P.001), especially opiates (P.001). Patients who underwent surgery constitute a vulnerable population during the COVID-19 pandemic, with poorer quality of life and had a much higher risk of depression. They are also polymedicated and prefrail, adhere well to COVID-19 preventive measures, and do not seem to fear visiting health centers.

The purpose of this study was to determine mid-long-term outcomes (5 years) following surgery for young adult idiopathic scoliosis (YAdIS).This is a retrospective review of a prospective, multicenter adult deformity database including patients operated on idiopathic scoliosis by a single posterior approach, age at surgery between 19 and 29 (considered young adults), and 5-year follow-up. Demographic, radiographic and PROMS were analyzed preoperatively, at 2 years and at final follow-up.Forty-two patients were included. Mean preoperative major curve angle was 59.65 ± 18.94. Main coronal curve initial correction was 56.38%, with 6% loss at 5 years. From baseline to 5 years after surgery, there was improvement in all PROMs (P 0.004)-especially self-image-, except NRS-leg pain. This improvement was present at 6 months for all PROMs except for functional outcomes (SRS-Function and ODI) in which the improvement took place between 6 months and 2 years. In the 2- to 5-year follow-up period, no significant changes were seen in any PROMs. The percentage of patients reaching MCID from baseline at 5 years was: 75% for SRS-image, 45% for SRS-pain, 47.5% for SRS-function, 51.3% for SRS-mental, 42.5% for SRS-total and 15.4% for ODI. Patients reaching PASS at 5 years were: 88.1% for SRS-image, 81% for SRS-pain, 92.9% for SRS-function, 57.1% for SRS-mental, 88.1% for SRS-total, 92.7% for ODI and 69% for NRS pain. 11 minor and 4 major complications were identified.YAdIS surgery resulted in an early and significant improvement in PROMs, especially for self-image, significantly reaching MCID and PASS thresholds. These results were maintained during long-term (5-year) follow-up.

After lumbar spinal surgery, symptomatic pneumocephalus is extremely rare, and is usually associated with a dural tear. We report a case of symptomatic compressive pneumocephalus following a degenerative lumbar spine surgery (decompression and pedicle screw fixation), without visible dural tear. The patient underwent emergency surgery by burr hole right frontal craniotomy on the fourth day after surgery and subsequent spinal reoperation with dural tear repair 2 weeks after de first surgery. A high degree of clinical suspicion is needed for timely diagnosis and treatment for timely diagnosis and treatment. When a confusion status and headache develop after surgery, CT scanning is essential to make the diagnosis of pneumocephalus. When the diagnosis is complete, conservative treatment is the choice for most of patients. In our case, tension pneumocephalus behaved like a space-occupying lesion threatening patients’ life.

Background Recently published data suggest that showing patients operated on for adolescent idiopathic scoliosis or kyphosis their preoperative and postoperative photographs may enhance their satisfaction and self-image as measured by Scoliosis Research Society Health-Related Quality of Life Questionnaire (SRS-22) scores. No data exist for adult spinal deformity (ASD) surgery. The aim of this study is to determine the effect on patient postoperative satisfaction and self-image of showing adult deformity patients their preoperative and postoperative whole body photographs. Methods This was a nonconcurrent prospective study. Patients operated on for ASD with a minimum 2-year postoperative follow-up who had preoperative full-body photographs taken by a professional photographer were included. Two follow-up visits were arranged 7 days apart. In the first visit, patients completed the SRS-22 questionnaire, and full-body standing photographs were taken. In the second visit, patients were asked to complete again questions 4, 6, 10, 14, 19 (self-image), 21, and 22 (satisfaction) of the SRS-22 after seeing their preoperative and postoperative full-body photographs. Results Thirty patients (28 female) were included. Themedian age at surgery was 50 years (26–76). The median follow-up was 51 months (24–120). SRS-22 results at first visit were: activity 2.79 ± 0.75; self-image 2.71 ± 0.82; pain 2.53 ± 1.10; mental health 3.08 ± 0.77; satisfaction 3.46 ± 1.20; global 2.74 ± 0.72. SRS22 results at second visit were: self-image 2.9 ± 0.75; satisfaction 4.02 ± 0.97. After seeing the preoperative and final follow-up photographs, patients experienced an improvement in SRS-22 self-image (P = .000) and satisfaction domains (P = .011). Conclusions In patients operated on for ASD, showing preoperative and postoperative photographs improves patient satisfaction with surgery and self-image. Level of Evidence 3. Clinical Relevance Our results could be a starting point for introducing full-body clinical photographs as a routine clinical tool in adult deformity patients undergoing surgery.

Resumen Antecedentes y objetivos El objetivo de este estudio es evaluar que factores pueden influir en la supervivencia de la artroscopia de cadera a medio plazo en el contexto de patologia degenerativa. Material y metodos Llevamos a cabo un estudio retrospectivo de 40 casos de una serie de 102 pacientes intervenidos de artroscopia de cadera en nuestro centro, desde agosto de 2007 a octubre de 2011. Al final del seguimiento, todos los pacientes cumplimentaron tres escalas funcionales: Hip Outcome Score-Activites of Daily Life (HOS-ADL), Hip Outcome Score-Sport (HOS-S) y Harris Hip Score modificado (HHSm). Resultados Finalmente se incluyo un total de 39 pacientes (40 caderas), con una edad media de 43,1 anos y un tiempo de seguimiento medio de 6 anos (43-130 meses). Los pacientes intervenidos con una edad inferior a 50 anos obtuvieron mejor puntuacion en las escalas HOS-S (25,2 puntos) y HHS-m (84,1 puntos) en comparacion con aquellos intervenidos a partir de dicha edad (HOS-S [25,2 puntos]; HHS-m [84,1 puntos]). El tiempo de evolucion tambien influyo significativamente en el resultado de nuestros pacientes, siendo mejor en aquellos en los que este era menor a 12 meses (26,6 meses), en comparacion con aquellos en los que era mayor (21,3 meses). Por otro lado, aquellos que presentaban una intervencion quirurgica lumbar previa obtuvieron peores resultados de HOS-ADL (49,3 puntos), respecto a aquellos que no presentaban este antecedente (56,5 puntos). El Patient acceptable symptom state (PASS) fue superado por 23 pacientes (57,5%), 22 pacientes (55%) y 25 pacientes (62,5%) en las escalas HHSm, HOS-ADL y HOS-S respectivamente. Ningun paciente presento ninguna complicacion mayor. Cuatro pacientes presentaron complicaciones menores. La supervivencia media obtenida fue de 97,1 meses (IC 95%, 85,1-109,1 meses), asociado con un 81% de pacientes (IC 95%, 69%-93%) que no preciso rescate quirurgico a los 10 anos. Conclusiones Creemos que los datos obtenidos en nuestra serie sugieren que la artroscopia de cadera en el contexto de patologia degenerativa es una intervencion quirurgica segura con un resultado funcional fiable a corto-medio plazo. Por otro lado, dicha indicacion deberia hacerse con mayor precaucion en pacientes sometidos previamente a cirugia lumbar. Nivel de evidencia Nivel IV. Serie de casos.

Background and purpose The purpose of this study is to identify which variables may have a significant impact in mid-term survivorship following hip arthroscopy. Methods This a single-centre single-surgeon retrospective study including 102 patients who underwent a hip arthroscopy procedure between August 2007 and October 2011. Each subject completed three questionnaires at final follow- up: “Hip "Outcome Score-Activities of Daily Living" (HOS-ADL), "Hip Outcome Score-Sport" (HOS-S) and " Modified Harris Hip Score “(m-HHS). Results Thirty-nine patients (40 hips) were finally included in our study. Mean age was 43.1 ± 9.9 years with a three-year minimum follow-up (75.43 ± 25.2 months). Younger patients and those with a shorter duration of symptoms obtained significantly higher HOS-S and m-HSS scores. Patients who had undergone previous lumbar spinal surgery obtained significantly worse HOS-ADL scores. Patient acceptable symptom state (PASS) was achieved in 23 patients (57.5%) for m-HHS, 22 patients (55%) for HOS-ADL and 25 patients for HOS-S scores. No major complication was observed. Only four patients had minor complications. Mean survival time was 97.1 months (95% CI, 85.1–109.1 months), with a survival at 8 years of 69% (95% CI, 53%–85%). Conclusions Our findings suggest that hip arthroscopy is a safe procedure with acceptable functional outcomes after a long follow-up. Care should be taken when treating patients with prior lumbar surgery. Level of evidence Level IV. Case series.

Study design This is nonconcurrent prospective study approved by the Institutional Research Ethics Committee. Objective The purpose of this study is to determine if the cranial sagittal vertical axis (Cr-SVA) measured in full spine standing radiographs is a better predictor of clinical results than the C7 sagittal vertical axis (C7-SVA) in adult patients operated on spinal deformity with a minimum 2-year follow-up after surgery. Summary of background data The Cr-SVA has recently been described as a better predictor of health-related quality of life outcomes than the C7-SVA for patients with adult spinal deformity (ASD) before undergoing surgery. This has not been confirmed in patients after ASD surgery. Methods Inclusion criteria were age at surgery more than 25 years and a minimum 2-year follow-up after a ≥5 level fusion for ASD. Full-length standing lateral radiographs (including nasion-inion line, spine, and femoral heads) and Scoliosis Research Society 22 Questionnaire and SF36 questionnaires were available for every patient at the final follow-up. The distance from the Cr-SVA to the posterior corner of S1 (Cr-SVA-S) and to the centers of the hip (Cr-SVA-H) was measured and also the C7-SVA, lumbar lordosis, pelvic incidence, pelvic tilt, and PI-LL. Results Sixty-five patients (58 female individuals) operated on ASD in a single institution were included. Age at surgery was 61 years (26-67). The mean follow-up was 53 months (24-120). Spearman rank-order test showed several significant correlations. After multivariable analysis, only Cr-SVA-S and age persisted as predictors for Scoliosis Research Society (SRS) image scores, Cr-SVA-H for SRS satisfaction, Cr-SVA-H and age for SRS total scores, Cr-SVA-H and age for SF36 Physical Function, Cr-SVA-S for SF36 Role Physical, Cr-SVA-H for SF36 Bodily Pain, and Cr-SVA-H for SF36 Role Emotional. Conclusions The Cr-SVA measured in full spine standing radiographs seems to be a better predictor of health-related quality of life outcomes than the C7-SVA for adults operated on spinal deformity >2 years after surgery.

Resumen Objetivo Describir las caracteristicas y la evolucion de la infeccion profunda en cirugia instrumentada de raquis toracolumbar (IPCITL) en nuestro centro en un periodo de 10 anos. Material y metodo Estudio descriptivo retrospectivo. Se analizan datos del paciente (epidemiologicos/salud), datos operatorios, presentacion de la infeccion, germenes cultivados, limpiezas quirurgicas requeridas, extraccion de los implantes y complicaciones significativas derivadas de la infeccion. Resultados Se revisan 110 pacientes (80 mujeres). El seguimiento medio tras el diagnostico de infeccion fue de 3,6 anos. Etiologias mas frecuentes: escoliosis idiopatica del adolescente, deformidad del adulto y estenosis lumbar degenerativa. El 62% de pacientes presentaban algun dato clinico que les hacia proclives a la infeccion. La aparicion de la infeccion fue precoz (0-3 meses de la cirugia primaria) en el 60,4% de los casos, retardada (3-24 meses) en el 11,7% y tardia (mas de 24 meses) en el 27%. Todos los pacientes fueron tratados mediante limpieza quirurgica. El 25% necesitaron mas de una limpieza. Se extrajeron los implantes en el 46% de los pacientes (en el 71% de ellos en la primera limpieza). Los germenes aislados con mayor frecuencia fueron Staphylococcus coagulasa-negativo, Propionibacterium acnes y Enterococcus. Hubo complicaciones significativas derivadas de la IPCITL en el 15% de casos. El 88% de ellas precisaron cirugias complejas para su tratamiento. Conclusiones Las IPCITL tardias son mas frecuentes de lo esperado segun la literatura. En IPCITL globalmente predominan germenes cutaneos. Las IPCITL provocan una alta tasa de complicaciones, que habitualmente requieren tratamiento mediante cirugias complejas.